Science Fiction Youth Program
Nomination Form for Recipients

Nominate a worthy recipient here so we can match the organization with a donor. Get
your local library, school, or other youth organization free
SF books and magazine subscriptions!

If this form doesn't work for you, or if you use an older web browser, send
an e-mail to Chris McKitterick for more information:

A printable text version of this enrollment form is
also available; this form requires that you have configured an email program on
the computer you are using.

Privacy information: Note that the Center coordinator for this project
(Chris McKitterick) is the only person who will see your personal information.
We will not share this personal information with any third party, except to
fulfill a magazine subscription or book request.

I want to register
an
organization to receive a subscription to an SF magazine

I want to register
an
organization to receive SF book(s)

I would like more information

I would like to be
added to a blind-cc mailing list-serve to discuss related topics

Your name:

Organization name:

Book or magazine preference (list as many as you wish):

Street address (where to send the books/magazines):

City:

State and Zip:

Phone number:

Organization's (or, if none, your) email address:

When you click "Submit," you might see a dialog box asking if you
really want your browser to send an email on your behalf, and it might ask if
this is expected behavior or a possible virus. This is normal behavior for
submitting a web form, so click "OK," "Send," or the equivalent.

If you have trouble using the form, e-mail Chris McKitterick for more information. A
printable text version of this form is also available.